What Are Your Therapy “Settings”? Structured Prompts for Describing One’s Clinical Style
While many therapists share key information such as areas of specialisation and a brief summary of their overall style on their websites, I realized that it’s much less common for clinicians to describe specific details such as how directive they are, how much they tend to self-disclose, how punctual they are, etc. The goal of this article is to introduce structured prompts which therapists could potentially use to provide a relatively comprehensive overview of their clinical approach. For example, this could potentially be shared as a supplementary page on a clinician’s website or as an optional reference during a consultation call.
In some cases, having access to this specific information might allow patients to better determine early on which clinicians are likely the best fit for their specific situation and needs. Additionally, it might help clinicians reflect on their clinical style and allow for earlier individualisation of therapy (namely, discussing therapeutic "settings" such as degree of self-disclosure during the intake process allows patients a good opportunity to share their own preferences with the clinician).
On the other hand, I realize there may be some drawbacks to the tool as well and don’t mean to imply that every practice would benefit from implementing this (or a similar tool). Below are some potential risks and (where applicable) ideas for mitigating them:
Even if a tool was perfectly designed (which this one almost certainly isn’t!), there is still some element of subjectivity—what a patient views as "moderate self-disclosure" and what the clinician views as "moderate self-disclosure" may be different.
Potential suggestion: Unfortunately, I can’t think of an easy way to mitigate this risk, other than potentially including brief written descriptions of numerical ratings to help calibrate or interpret them.
It is possible that sharing detailed information about one’s typical clinical approach upfront could introduce its own complications (e.g. while some patients may find it helpful or reassuring, others might find it overwhelming or might feel guilty if they want an approach that is different from what their clinician typically defaults to). Clinicians may also understandably have privacy concerns about the degree of detail in which they describe themselves and their approach on a website.
Potential suggestion: Clinicians could pick from the prompt set only the items that seem most relevant to their practice or most straightforward, and responses could be stored as a supplemental file so that only interested patients who actively choose to view them do so.
Similar to the above, there is a risk that any tool flattens the way that clinical care can adapt to a specific patient and their specific situation. For example, a clinician may generally default to using relatively little self-disclosure but may be more than happy to increase it when it seems therapeutically appropriate or when a patient expresses a preference for it.
Potential suggestion: Instead of describing a single fixed setting, clinicians could describe the range they typically use (e.g. "little–moderate self-disclosure"), note where they generally begin while acknowledging that they often adapt their approach to individual patients, or remove items where they genuinely do not have a consistent default approach.
As with anything humans do, it is unfortunately very possible that clinicians may not be able to self-assess their practice with complete accuracy. For example, research (Probst et al., 2022) has found that therapists tend to overestimate the extent to which patients in their care are improving and most rate themselves as above average. It may be possible that a clinician genuinely desires to be open to feedback but, in practice, is less open and more defensive than they want to believe, potentially skewing ratings for the tool.
Potential suggestion: While I don’t know of a way to adjust for this, the tool largely aims to avoid "good" or "bad" answers and instead focuses on (mostly) neutral dimensions where different patients are likely to benefit from different approaches.
Disclaimer: I am not a clinician and this is not an official tool! Rather, this is mostly a thought experiment about what sorts of questions or prompts may potentially be helpful in clinical care.
Possible prompts
For all prompts, if the answer varies substantially depending on the patient or situation, feel free to describe your usual range or default approach instead of selecting a single point.
Clinical style
Self-disclosure: On a scale of 1 to 5 where 1 is "hardly at all/mostly a blank slate" and 5 is "quite a bit", to what extent do you typically use self-disclosure in sessions?
Structure of therapy: On a scale of 1 to 5 where 1 is "sessions are largely responsive to what the patient wants to discuss that day" and 5 is "sessions are largely structured or directed by me (based on the patient's long-term goals)", to what extent do you typically structure or direct therapy?
Between-session work: On a scale of 1 to 5 where 1 is "I rarely suggest structured activities or homework between sessions" and 5 is "I frequently encourage structured practice or homework between sessions", how would you describe your usual approach?
Focus of therapy: On a scale of 1 to 5 where 1 is "I tend to focus primarily on current situations in my patient’s life" and 5 is "I tend to spend substantial time exploring past experiences in my patient’s life and how they contribute to the present", where do you generally begin?
Detail orientation: On a scale of 1 to 5 where 1 is "I am particularly strong at seeing or discussing the 'big picture' with patients" and 5 is "I am particularly strong at discussing details and specific nuances of situations with patients", to what extent do you consider yourself more big-picture versus detail-oriented?
Emotional expression: On a scale of 1 to 5 where 1 is "I tend to come across as quite emotionally reserved or neutral as a clinician" and 5 is "I tend to be very emotionally expressive", to what extent do you consider yourself emotionally expressive?
Supporting change: Patients sometimes describe therapists as being more validating or more challenging. When there is tension between validating a patient's current perspective and encouraging change, where do you generally find yourself beginning?
Sharing observations with patients: On a scale of 1 to 5 where 1 is "I often allow patients to arrive at conclusions in their own time, without sharing many of my own observations directly" and 5 is "I frequently share my observations, interpretations, and clinical thinking during sessions", how would you describe your usual approach?
Feedback: On a scale of 1 to 5 where 1 is "I generally trust that patients will share feedback or advocate for themselves if they would like something to change" and 5 is "I regularly and proactively invite feedback and check in about how therapy is feeling", how would you describe your approach to feedback?
Practice logistics
Punctuality: On a scale of 1 to 5 where 1 is "I am often somewhat late" and 5 is "I am virtually always on time or early", to what extent do you describe yourself as punctual?
Session ending time: On a scale of 1 to 5 where 1 is "I virtually always end sessions at the scheduled time" and 5 is "I am usually pretty flexible with the ending time", to what extent do you describe yourself as flexible with session ending times?
Scheduling predictability: While it isn’t possible to know the future entirely and the unexpected can happen to anyone, do you currently anticipate changes in your life that might cause you to have to end work with a patient earlier than anticipated or reschedule meetings frequently? On a scale of 1 to 5, let 1 be "nothing anticipated" and 5 be "yes, I have likely or significant extenuating circumstances."
Communication between sessions: What is your general approach to communication between sessions? (None, scheduling only, significant life events, other.)
General
What kinds of patients or therapeutic situations do you think are generally a particularly good fit for your approach?
Are there any parts of your clinical practice that you think are most likely to cause stress for patients? (For example, a clinician may have external circumstances that cause them to cancel appointments on short notice relatively frequently. Or a clinician who has very strict boundaries might not be a good fit for a patient who needs flexibility, and vice versa.)
Are there areas that are outside of your scope of practice?
Are there specific identities, communities, or lived experiences that you feel especially knowledgeable about?
Are there any situations where you would generally recommend another clinician with more specialised expertise (e.g. if a patient was hoping to focus on a specific identity or experience you are less familiar with)?
To what extent are you currently able to take on ongoing training or learning if a patient suggests it? (For example, if a patient has an uncommon condition and would like you to read an article or watch a video to learn more about it, is that something you would generally be open to or have the bandwidth for?)
